推拿康复联合低频重复经颅磁刺激对脑卒中偏瘫患者脑血流动力学及肌张力的影响

Effect of massage rehabilitation combined with low-frequency repetitive transcranial magnetic stimulation on cerebral hemodynamic and muscle tone in stroke hemiplegia patients

目的探讨推拿康复联合低频重复经颅磁刺激对脑卒中偏瘫患者脑血流动力学及肌张力的影响。方法研究对象为2021-06—2023-06复旦大学附属华山医院、上海市第三康复医院收治的脑卒中偏瘫患者112例,依据随机数字法分为观察组和对照组,各56例。对照组采取低频重复经颅磁刺激治疗,观察组在此基础上采取推拿康复治疗。比较2组患者治疗前后血流动力学指标[双侧大脑动脉血流平均流速(Vm)、血流最大峰值(Vs)以及血管阻力指数(RI)]、上肢肌张力等级变化情况,以及肢体功能、生活能力评分,并统计2组临床疗效。结果观察组治疗总有效率83.93%(47/56),明显高于对照组的64.29%(36/56),差异有统计学意义(P<0.05)。观察组治疗后Vm、Vs明显高于对照组,RI明显低于对照组,差异有统计学意义(P<0.05)。观察组治疗后改良Ashworth痉挛量表评级0级、Ⅰ级的占比为60.71%(34/54),明显高于对照组的42.86%(24/56),差异有统计学意义(P<0.05)。观察组治疗后Fugl-Meyer运动功能评定量表评分、Barthel指数均明显高于对照组,差异有统计学意义(P<0.05)。结论推拿康复联合低频重复经颅磁刺激治疗脑卒中偏瘫,能够有效改善患者脑血流动力学及肌张力亢进,有助于肢体功能及生活能力的恢复,具有较好的疗效。

Objective To investigate the effect of massage rehabilitation combined with low-frequency repetitive transcranial magnetic stimulation on cerebral hemodynamic and muscle tone in stroke hemiplegia patients.Methods Totally 112 patients with stroke and hemiplegia admitted to Huashan Hospital,Fudan University and Shanghai Third Rehabilitation Hospital from June 2021 to June 2023 were selected as study subjects,which were divided into observation group and control group by the random number method,with 56 cases in each group.The control group adopted low-frequency repetitive transcranial magnetic stimulation,and the observation group took massage rehabilitation treatment on this basis.The hemodynamic indexes(mean flow of blood flow rate of bilateral cerebral arteries(Vm),maximum peak blood flow(Vs)and vascular resistance index(RI)),the score of upper limb muscle tone grade,and the clinical efficacy of the two groups were compared.Results The overall response rate in the observation group was 83.93%(47/56),and was significantly higher than that of 64.29%(36/56)in the control group.The difference was statistically significant(P<0.05).Vm and Vs in the observation group were significantly higher than those in the control group,RI was significantly lower than that in the control group,the differences were statistically significant(P<0.05).The proportion of modified Ashworth grade 0 andⅠof observation group was 60.71%(34/54),and was significantly higher than 42.86%(24/56)of the control group,the difference was statistically significant(P<0.05).The scores of Fugl-Meyer assessment scale and Barthel index in the observation group were significantly higher than those in the control group,the differences were statistically significant(P<0.05).Conclusion The massage rehabilitation combined with low-frequency repetitive transcranial magnetic stimulation for stroke hemiplegia can effectively improve cerebral hemodynamics and muscle tension,contribute to the recovery of limb function and life ability,and has a good effect.